No need to review telemedicine standards and requirements after MaNaDr case: Ong Ye Kung

SINGAPORE – There is no need for Singapore to review its current telemedicine standards and requirements, especially as enforcement has been effective in going after errant operators, said Health Minister Ong Ye Kung in Parliament on Nov 11.

“Regulatory frameworks do not eradicate offences, which is impossible. Instead, it ensures that when practices have gone astray, especially with the advent of new technology and business models, they can be corrected promptly,” he added.

The minister was responding to parliamentary questions filed by Dr Wan Rizal (Jalan Besar GRC) and Ms Hany Soh (Marsiling-Yew Tee GRC) on measures put in place to ensure that telehealth operators meet patient care standards, and whether additional regulatory frameworks will be put in place following

lapses identified at telemedicine operator MaNaDr Clinic.

The clinic’s doctors were

found to have conducted teleconsultations of less than a minute,

issued multiple medical certificates (MCs) within a short period such as 30 days, and maintained extremely sparse patient case notes.

MaNaDr Clinic’s licence for providing outpatient medical services physically, remotely and at temporary premises such as patients’ residences is set to be revoked.

Mr Ong said telemedicine providers are required to be licensed under the Healthcare Services Act (HCSA) and to comply with requirements and standards.

For example, under regulations in the HCSA governing outpatient medical services, operators offering teleconsultations must ensure that the service is done through real-time, two-way interactive audiovisual communications and that the medical professional is conducting the consultation in a place that is closed and private.

Medical practitioners also need to adhere to the ethical and professional standards set out in the Singapore Medical Council’s (SMC) Ethical Code and Ethical Guidelines (ECEG).

Under the ECEG, practitioners must obtain sufficient information from their patients, conduct appropriate clinical assessment, and ensure that any provision of medical care, prescription of medicines and issuance of MCs are justified on proper medical grounds.

Mr Ong pointed out that the Ministry of Health conducts audits on telehealth licensees.

“If you, despite knowing all these, fall foul of the regulations and also the SMC ethical guidelines, then you’re in trouble because we will catch you. And even if we do not catch you, people will complain,” said Mr Ong.

He added that in the case of MaNaDr, the authorities had received complaints from patients and employers that doctors were turning around consultations too fast and that some staff had even applied for MCs while they were overseas.

“While the offence went on for a while, it wasn’t a long while. It was a matter of months and we took action... and corrected the situation,” said the Health Minister.

Mr Ong also pointed out that HCSA was just recently enacted, and took into account the post-pandemic healthcare system and ageing population, where technology is used to deliver services.

The legislation was enacted in 2020 to replace the Private Hospitals and Medical Clinics Act, and its implementation was done progressively in three phases and completed in end-2023.

Mr Ong said that with new technology like telemedicine, there are opportunities to serve patients and residents better. But just like all new technology and business models, there will be instances of abuse.

“Questions will be raised – is the ministry stepping up audits, enforcement, regulation or clamp(ing) down? There is always a temptation to do so, and when you do so, you cease being able to seize the opportunities that the new technology presents you,” he added.

“It is by good enforcement, following up on our standards and enforcing them, and taking necessary actions, then we can fully utilise and leverage opportunities that new business models and technology can offer us.”